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Published on: August 7, 2017
Heterogeneity of Mild to Moderate Persistent Asthma in Children: Confirmation by Latent Class Analysis and
Anne M Fitzpatrick1, Leonard B Bacharier2, Daniel J Jackson3
1Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga.
Insights
This study identified five distinct subgroups of children with mild to moderate asthma. Allergic sensitization and lung function are key indicators for predicting future asthma exacerbations in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Clinical Phenotyping
Background:
- Phenotypic characterization of pediatric asthma is limited, hindering prediction of poor outcomes.
- Identifying at-risk children with asthma is crucial for effective management.
Purpose of the Study:
- To identify latent classes in children with mild to moderate asthma.
- To determine if these classes predict future lung function and exacerbation rates.
Main Methods:
- Latent class analysis of 2593 children (aged 5-18) with mild to moderate asthma.
- Utilized 19 variables including demographics, symptoms, lung function, and allergic sensitization.
- Assessed lung function and exacerbation rates at 12-month follow-up.
Main Results:
- Identified five distinct latent classes with varying features (demographics, asthma control, sensitization, type 2 inflammation, lung function).
- Exacerbation rates differed across classes, with higher rates in those with airflow limitation.
- Lung function abnormalities persisted in one class at 12 months.
Conclusions:
- Pediatric asthma is heterogeneous; latent classes reveal distinct patient subgroups.
- Allergic sensitization and lung function are valuable for predicting exacerbation risk.
- Further research is needed to link latent classes to phenotypes for personalized asthma treatment.
Background:
Compared with adults, phenotypic characterization of children with asthma is still limited and it remains difficult to predict which children with asthma are at highest risk for poor outcomes.
Objective:
To identify latent classes in a large population of treatment-adherent children with mild to moderate asthma enrolled in clinical trials and determine whether latent class assignment predicts future lung function abnormalities and exacerbation rate.
Methods:
Latent class analysis was performed on 2593 children with mild to moderate asthma aged 5 18 years, with 19 variables encompassing demographic characteristics, medical history, symptoms, lung function, allergic sensitization, and type 2 inflammation. Outcomes included lung function and the annualized exacerbation rate at 12 months of follow-up.
Results:
Five latent classes were identified with differing demographic features, asthma control, sensitization, type 2 inflammatory markers, and lung function. Exacerbation rates were 1.30 ± 0.12 for class 1 (multiple sensitization with partially reversible airflow limitation), 0.90 ± 0.05 for class 2 (multiple sensitization with reversible airflow limitation), 0.87 ± 0.08 for class 3 (lesser sensitization with reversible airflow limitation), 0.87 ± 0.05 for class 4 (multiple sensitization with normal lung function), and 0.71 ± 0.06 for class 5 (lesser sensitization with normal lung function). Lung function abnormalities persisted in class 1 at 12 months.
Conclusions:
Children with mild to moderate asthma are a heterogeneous group. Allergic sensitization and lung function may be particularly useful in identifying children at the greatest risk for future exacerbation. Additional studies are needed to determine whether latent classes correspond to meaningful phenotypes for the purpose of personalized treatment.
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